Method and device for reducing angulation error during dental procedures

ABSTRACT

A device for reducing angulation error during the placement of dental implants or other dental procedures. Two or more sensors are used to monitor realtime orientation of a dental handpiece. One or more signal emitters are used in order to notify the user that a first orientation of the dental handpiece has been identified and recorded. One or more signal emitters are used to notify the user that the dental handpiece has been repositioned into a second orientation having a predetermined spatial relationship to the first orientation.

INCORPORATION BY REFERENCE OF RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.13/744,191, titled “Method and Device for Reducing Angulation ErrorDuring Dental Procedures,” filed Jan. 17, 2013, issuing as U.S. Pat. No.9,179,987 on Nov. 10, 2015, which claims the benefit of U.S. ProvisionalPatent Application No. 61/610,259, titled “Method and Device for PlacingDental Implants,” filed Mar. 13, 2012. The entire disclosure of eachitem listed above is incorporated in this disclosure by reference andmade a part of this specification.

BACKGROUND

The placement of dental implants requires precise angulation for thebest aesthetic result and longevity of the restorations that are fixedto the implants. Further, precise angulation is particularly importantfor proper implant functioning when occlusal forces are applied to theimplant, as well as for prosthesis retention with overdentures.Additionally, improperly aligned implants can adversely affect theaccuracy of impressions. Where two or more than two dental implants areimplanted to support a restoration, precise angulation of the dentalimplants relative to each other is also required for the best functionand longevity, and the least maintenance of the restoration that arefixed to implants.

Several factors can affect the alignment of implants, includinganatomical variations and aesthetics, leading to sub-optimal alignment.A variety of techniques have been used to decrease angulation errorduring the placement of dental implants. For example, computernavigation programs have been used to produce surgical templates thatguide implant placement to avoid vital structures, enhance estheticpositioning, direct placement into areas of limited bone, and permit theuse of a flapless technique. These techniques increase the precision ofthe angular placement of dental implants, but disadvantageously, requirecone beam computed tomography (CBCT) scans, and substantial training andpre-implant planning, thereby adding to the cost and time for treatment.

Therefore, there is a need for a new method for reducing angulationerror during the placement of dental implants.

SUMMARY

According to one embodiment of the present invention, there is provideda device for reducing angulation error during dental procedures, such asduring the placement of dental implants. The device comprises, a) two ormore than two sensors that monitor realtime orientation of the device inspace; b) a programmable computer processor comprising both an inputchannel and an output channel connected to the two or more than twosensors; c) a computer-sensor interface for connecting to a computer forprogramming the device and for receiving and manipulating data from thedevice, the computer-sensor interface connected to the programmablecomputer processor; d) one or more than one signal emitter connected tothe computer-sensor interface through the output channel for emittingone or more than one signal; and e) an actuator connected to theprogrammable computer processor by way of the input channel.

In one embodiment, the two or more than two sensors is two sensors. Inanother embodiment, the two or more than two sensors is three sensors.In another embodiment, the two or more than two sensors are selectedfrom the group consisting of an accelerometer, a gyroscope and amagnetometer. In another embodiment, the two or more than two sensorsare an accelerometer and a gyroscope. In another embodiment, the two ormore than two sensors are an accelerometer, a gyroscope and amagnetometer.

In one embodiment, the device further comprises an integral computerconnected to the computer-sensor interface for programming the device.In another embodiment, the device further comprises an integral powersupply for supplying power to the device. In another embodiment, the oneor more than one signal emitter is one signal emitter. In anotherembodiment, the one or more than one signal emitter is a plurality ofsignal emitters. In another embodiment, the one or more than one signalemitter is two signal emitters. In another embodiment, the one or morethan one signal emitter is three signal emitters. In another embodiment,the one or more than one signal emitter emits one or more than onesignal selected from the group consisting of an audible signal, avisible signal and both an audible and a visible signal. In anotherembodiment, at least one of the one or more than one signal emitters isintegral with the device. In another embodiment, at least one of the oneor more than one signal emitter is not integral with the device. Inanother embodiment, the actuator is integral with the device. In anotherembodiment, the actuator is not integral with the device.

According to another embodiment of the present invention, there isprovided a system for reducing angulation error during the placement ofdental implants. The system comprises, a) a device with two or moresensors that monitor realtime orientation of the device in space; aprogrammable computer processor comprising both an input channel and anoutput channel connected to the two or more sensors; a computer-sensorinterface for connecting to a computer for programming the device andfor receiving and manipulating data from the device, the computer-sensorinterface connected to the programmable computer processor; one or moresignal emitter connecter to the computer-sensor interface through theoutput channel for emitting one or more signal; an actuator connected tothe programmable computer processor by way of the input channel; and b)a dental handpiece connected to the device. In one embodiment, thedevice is integrally attached to the dental handpiece. In anotherembodiment, the device is reversibly attached to the dental handpiece.In a preferred embodiment, the dental handpiece is a dental drill.

According to another embodiment of the present invention, of the presentinvention there is provided a method for reducing angulation errorduring the placement of dental implants. The method comprises, a)providing a device according to the present invention; b) actuating thedevice to identify and record a first orientation comprising three axialplanes (X, Y and Z), where the signal emitter of the device emits one ormore than one signal to confirm that the device has identified andrecorded the first orientation; and c) reorienting the system to asecond orientation comprising three axial planes (X, Y and Z) and havinga predetermined spatial relationship to the three axial planes (X, Y andZ) of the first orientation; where the one or more than one signalemitted confirming that the device has identified and recorded the firstorientation is selected from the group consisting of an audible signal,a visible signal and both an audible and a visible signal. In oneembodiment, the method further comprises identifying a patient with aloss of a tooth or teeth requiring one or more than one dental implant.In another embodiment, the method further comprises providing a dentalhandpiece, and attaching the device to the dental handpiece to create asystem. In another embodiment, the device provided is part of a systemcomprising a dental handpiece. In one embodiment, the dental handpiececomprises a dental drill. In one embodiment, the method furthercomprises using the dental handpiece of the system to create a firstosteotomy for a first implant in the mandible or maxilla of the patient.In another embodiment, the first orientation is recorded for anosteotomy. In another embodiment, the first orientation is recorded fora structure selected from the group consisting of an existing implant, aparalleling pin, a root socket, a template and a tooth. In anotherembodiment, the second orientation is the site of an implant in themandible or maxilla of a patient. In another embodiment, thepredetermined spatial relationship between one or more than one axisplane of the second orientation to the corresponding one or more thanone axis plane of the first orientation is parallel. In anotherembodiment, the predetermined spatial relationship between one or morethan one axis plane of the second orientation to the corresponding oneor more than one axis plane of the first orientation is not parallel. Inone embodiment, the device emits one or more than one signal to confirmthat the device is at the second orientation, and the method furthercomprises relocating the system until the device emits one or more thanone signal, thereby indicating that the device is at the secondorientation, where the one or more than one signal emitted when thedevice is at the second orientation is selected from the groupconsisting of an audible signal, a visible signal and both an audibleand a visible signal. In one embodiment, the device emits one or morethan one signal to confirm that the device is not at the secondorientation, and the method further comprises relocating the systemuntil the device ceases to emit one or more than one signal, therebyindicating that the device is at the second orientation, where the oneor more than one signal emitted when the device is not at the secondorientation is selected from the group consisting of an audible signal,a visible signal and both an audible and a visible signal. In anotherembodiment, the method further comprises using the dental handpiece ofthe system to create a second osteotomy. In another embodiment, one ofthe sensors of the device is a magnetometer, and the method furthercomprises deactivating the magnetometer before identifying and recordingthe first orientation.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

These and other features, aspects and advantages of the presentinvention will become better understood with regard to the followingdescription, appended claims, and accompanying drawings where:

FIG. 1 is a schematic representation of a device according to thepresent invention;

FIG. 2 is a lateral perspective view of a system according to thepresent invention comprising a device according to the presentinvention; and

FIG. 3 is a top perspective view of the system shown in FIG. 2.

DETAILED DESCRIPTION

According to one embodiment of the present invention, there is provideda device for reducing angulation error during dental procedures, such asduring the placement of dental implants. In one embodiment, the devicecomprises two or more than two sensors that monitor realtime orientationof the device in space. According to another embodiment of the presentinvention, there is provided a system for reducing angulation errorduring dental procedures, such as during the placement of dentalimplants. In one embodiment, the system comprises a device according tothe present invention and further comprises a dental handpiece.According to another embodiment of the present invention, there isprovided a method for reducing angulation error during dentalprocedures, such as during the placement of dental implants. In oneembodiment, the method comprises providing a device according to thepresent invention or providing a system according to the presentinvention. The device, system and method are disclosed primarily withrespect to dental implants. However, as will be understood by those withskill in the art with respect to this disclosure, the device, system andmethod can be used for other procedures. The device, system and methodwill now be disclosed in detail.

As used in this disclosure, except where the context requires otherwise,the term “comprise” and variations of the term, such as “comprising,”“comprises” and “comprised” are not intended to exclude other additives,components, integers or steps.

As used in this disclosure, except where the context requires otherwise,the method steps disclosed are not intended to be limiting nor are theyintended to indicate that each step is essential to the method or thateach step must occur in the order disclosed.

As used in this disclosure, the term “dental handpiece” includes adental drill (dentist's drill) with or without a power source, as wellas other dental instruments and tools useful with a device according tothe present invention, as will be understood by those with skill in theart with respect to this disclosure.

As used in this disclosure, “restoration” includes a crown, a fixedcomplete denture, a fixed partial denture (bridge) and a removablepartial denture (overdenture), as will be understood by those with skillin the art with respect to this disclosure.

According to one embodiment of the present invention, there is provideda device for reducing angulation error during dental procedures, such asduring the placement of dental implants to receive a restoration.Referring now to FIG. 1, there is shown a schematic representation of adevice according to the present invention. As can be seen, the device 10comprises two or more than two sensors, here shown with three sensors12, 14 and 16 as an example only. The sensors 12, 14 and 16 monitorrealtime orientation of the device in space in three axial planes (X, Yand Z). In a preferred embodiment, the device comprises two sensors. Ina particularly preferred embodiment, the device comprises three sensors.In one embodiment, the two or more than two sensors 12, 14 and 16 areselected from the group consisting of an accelerometer, a gyroscope anda magnetometer. In a preferred embodiment, the two or more than twosensors comprise an accelerometer and a gyroscope. In a particularlypreferred embodiment as shown in FIG. 1, the device comprises threesensors, an accelerometer 12, a gyroscope 14 and a magnetometer 16. Theuse of a plurality of sensors allows each sensor to partially compensatefor angulation error made by the other sensor or sensors, therebydecreasing total angulation error during dental procedures, such asduring the placement of dental implants that would result from not usinga sensor or from using a single sensor only.

In one embodiment, the device 10 further comprises a programmablecomputer processor 18 connected to the two or more than two sensors, andcomprising both an input channel 20 and an output channel 22. In oneembodiment, the device 10 further comprises a computer-sensor interface24 connected to the programmable computer processor 18, thecomputer-sensor interface 24 connecting to a computer for programmingthe device 10 and for receiving and manipulating data from the device10. In one embodiment, the device 10 further comprises an integralcomputer 26 connected to the computer-sensor interface 24 forprogramming the device 10, though a separate, non-integral computer canbe used with an embodiment of the device 10 that lacks an integralcomputer 26, as will be understood by those with skill in the art withrespect to this disclosure. In one embodiment, the device 10 furthercomprises an integral power supply 28 for supplying power to the device10, though a separate, non-integral power supply can be used with anembodiment of the device 10 that lacks an integral power supply 28, aswill be understood by those with skill in the art with respect to thisdisclosure.

In one embodiment, the device 10 further comprises one or more than onesignal emitter 30 connected to the computer-sensor interface 18 throughthe output channel 22, as will be understood by those with skill in theart with respect to this disclosure. In one embodiment, the one or morethan one signal emitter 30 is one signal emitter 30 (as shown in FIG. 1in the solid lines). In a preferred embodiment, the one or more than onesignal emitter 30 is a plurality of signal emitters 30. In aparticularly preferred embodiment, the one or more than one signalemitter 30 is two signal emitters 30. In a particularly preferredembodiment, the one or more than one signal emitter 30 is three signalemitters 30 (as shown in FIG. 1 in the solid and broken lines). In oneembodiment, the one or more than signal emitter 30 emits an audiblesignal (a sound). In another embodiment, the one or more than signalemitter 30 emits a visible signal (a light). In a preferred embodiment,the one or more than signal emitter 30 emits both an audible and avisible signal.

In one embodiment, one or more of the one or more than one signalemitters 30 is integral with the device 10 (directly attached to theremainder of the device 10). In one embodiment, all of the one or morethan one signal emitters 30 is integral with the device 10. In anotherembodiment, one of the one or more than one signal emitters 30 isnon-integral with the device 10 (at a significant distance, such as forexample between 0.5 and 10 meters, from the remainder of the device 10).In one embodiment, all of the one or more than one signal emitters 30 isnon-integral with the device 10.

In one embodiment, the device 10 further comprises an actuator 32 foroperating the device 10 connected to the programmable computer processor18 through the input channel 20, as will be understood by those withskill in the art with respect to this disclosure. In one embodiment, theactuator 32 is integral with the device 10 (directly attached to theremainder of the device 10). In another embodiment, the actuator 32 isnon-integral with the device 10 (at a significant distance, such as forexample between 0.5 and 10 meters, from the remainder of the device 10).

In one embodiment, the device 10 operates in one mode. In a preferredembodiment, the device 10 operates in two modes. One mode of the twomodes, Axial Inclination Mode, allows a user to record the orientationin space of the device 10 in three axial planes (X, Y and Z) at a firstorientation in space (the reference orientation), and then signals theuser when the device 10 is oriented in a second orientation, where twoof the axial planes of the second orientation are related to two of thecorresponding axial planes of the first orientation by a predetermineddeviation. Signaling the user can be either emitting one or more thanone signal from the one or more than one signal emitters 30, or can beceasing to emit one or more than one signal from the one or more thanone signal emitters 30. For example, if the device 10 is being used toprepare the axial walls of a mandibular molar, the occlusal plane is thefirst orientation and the predetermined deviation for the secondorientation of two of the axial planes from the first orientation is 3degrees for the facial and lingual axial surface preparation, and 3degrees for the mesial and distal axial surface preparation.

Another mode of the two modes, Angle Reproduction Mode, allows a user torecord the orientation in space of the device 10 in three axial planes(X, Y and Z) at a first orientation in space (the referenceorientation), and then signals the user when the device 10 is orientedin a second orientation, where all three axial planes of the secondorientation are related to all three corresponding axial planes of thefirst orientation by a predetermined deviation (for example less than orequal to 0.5 degrees deviation in space).

In one embodiment, at least one of the one or more than one signalemitters 30 emits a signal when the device 10 is oriented at the secondorientation and the signal would emit as long as the device 10 wasoriented at the second orientation prompting the operator to maintainthe second orientation of the device 10 during part or all of treatment.In another embodiment, at least one of the one or more than one signalemitters 30 ceases to emit a signal when the device 10 is oriented atthe second orientation and the signal would not emit as long as thedevice 10 was oriented at the second orientation prompting the operatorto maintain the second orientation of the device 10 during part or allof treatment;

In one embodiment, the device 10 further comprises a digital readout(such as for example two different LED number screens, or a readout onthe computer 26) that allow the user to set a specific degree ofrotation in two axial planes using control buttons (+/−) to establishthe desired relationship between the first orientation and the secondorientation.

As will be understood by those with skill in the art with respect tothis disclosure, by attaching the device 10 to a dental hand piece sothat the device 10 and dental hand piece move as a single unit, the useris able to maintain the dental handpiece within an orientation suitablefor the dental implant, thereby reducing angulation error of the dentalimplant. This helps reduce the error caused by improper visualization orjudgement by the surgeon.

According to another embodiment of the present invention, there isprovided a system for reducing angulation error during dentalprocedures, such as during the placement of dental implants. Referringnow to FIG. 2 and FIG. 3, there are shown respectively, a lateralperspective view of a system according to the present inventioncomprising a device according to the present invention (FIG. 2); and atop perspective view of the system shown in FIG. 2 (FIG. 3). As can beseen, the system 34 comprises a device 10 according to the presentinvention and further comprises a dental handpiece 36. In a preferredembodiment, the device 10 is integrally attached to the dental handpiece36. In a preferred embodiment, the device 10 is reversibly attached tothe dental handpiece 36, such as for example by correspondingmale/female type connectors.

In a preferred embodiment, both the device 10 according to the presentinvention, the dental handpiece 36, and the system 34 according to thepresent invention are sterilizable for repeat uses.

According to another embodiment of the present invention, there isprovided is a method for reducing angulation error in a dentalprocedure. The method will now be disclosed with respect to reducingangulation error during dental procedures, such as during the placementof dental implants as an example. The method can be used with otherdental procedures using corresponding steps, as will be understood bythose with skill in the art with respect to this disclosure. The methodcomprises identifying a patient with a loss of a tooth or teethrequiring one or more than one dental implant in preparation forproviding a crown, a fixed complete denture, a fixed partial denture(bridge) and a removable partial denture (overdenture) to replace thelost tooth or teeth. In a preferred embodiment, the patient is a human.

In one embodiment, the method comprises providing a device according tothe present invention, and the method further comprises providing adental handpiece, and attaching the device to the dental handpiece,thereby producing a system according to the present invention. Inanother embodiment, the method comprises providing a system according tothe present invention.

In one embodiment, the method comprises using the dental handpiece ofthe system to create a first osteotomy for a first implant in themandible or maxilla of the patient, and the method further comprisesactuating the device part of the system to identify and record theorientation of the first osteotomy as a first orientation (referenceorientation) while the dental handpiece is still located in the firstosteotomy. In another embodiment, the method comprises using the dentalhandpiece of the system to identify and record a first orientation of astructure, other than a first osteotomy, as will be understood by thosewith skill in the art with respect to this disclosure. In oneembodiment, the structure is selected from the group consisting of anexisting implant, a paralleling pin, a root socket, a template (such asfor example a surgical or radiographic template) and a tooth. In apreferred embodiment, the first orientation is identified and recordedwith reference to three axial planes (X, Y and Z).

In one embodiment, the signal emitter of the device emits a signal toconfirm that the device has identified and recorded the firstorientation. In one embodiment, the signal is an audible signal (asound). In another embodiment, the signal is a visible signal (a light,such as for example a light-emitting diode (LED)). In a preferredembodiment, the signal is both an audible and a visible signal.

Then, the method comprises reorienting the system to a secondorientation comprising three axial planes (X, Y and Z) having apredetermined spatial relationship to the first orientation, such as forexample to the site of an implant in the mandible or maxilla of thepatient. In one embodiment, the predetermined spatial relationshipbetween one or more than one axis plane of the second orientation to thecorresponding one or more than one axis plane of the first orientationis parallel. In one embodiment, the predetermined spatial relationshipbetween one or more than one axis plane of the second orientation to thecorresponding one or more than one axis plane of the first orientationis not parallel. In one embodiment, the device emits one or more thanone signal to confirm that the device is at the second orientation, andthe method further comprises relocating the system until the deviceemits one or more than one signal, thereby indicating that the device isat the second orientation. In another embodiment, the device emits oneor more than one signal to confirm that the device is not at the secondorientation, and the method further comprises relocating the systemuntil the device ceases to emit one or more than one signal, therebyindicating that the device is at the second orientation. In oneembodiment, the signal is an audible signal (a sound). In anotherembodiment, the signal is a visible signal (a light, such as for examplea light-emitting diode (LED)). In a preferred embodiment, the signal isboth an audible and a visible signal. In one embodiment, one or morethan one of the one or more than one signal is repeated a plurality oftimes during confirmation.

Then, the method comprises using the dental handpiece of the system tocreate a second osteotomy for a second implant in the mandible ormaxilla of the patient, thereby producing the second osteotomy with thesecond orientation having the predetermined spacial relationship to thefirst orientation within a specific tolerance, and thereby reducingangulation error with respect to the first osteotomy.

As will be understood by those with skill in the art with respect tothis disclosure, the method can be used to place dental implants thatare parallel to each other or can be used to produce dental implantsthat are oriented at a predetermined spatial relationship to oneanother, or to another structure. In one embodiment, the method furthercomprises using the system to place one or more than one additionalimplant having a predetermined spatial relationship to the first implantor another structure, as will be understood by those with skill in theart with respect to this disclosure. In one embodiment, the method isused to place two or more than two implants. In a preferred embodiment,the method is used to place three implants. In a preferred embodiment,the method is used to place two or more than two implants that areparallel to each other.

In one embodiment, the device part of the system comprises amagnetometer, and the method further comprises deactivating themagnetometer before identifying and recording the first orientation ofthe first osteotomy as the reference orientation, or before actuatingthe device part of the system to identify a second orientation of thedental handpiece to prevent a magnetic field created by the dentalhandpiece from interfering with the operation of the device part of thesystem, as will be understood by those with skill in the art withrespect to this disclosure.

Example 1 Reduction of Angulation Error

The device, system and method according to the present invention weretested as follows. The study was performed using twenty third-yeardental students and five experienced clinicians (having placed more than100 implants). Participants were numbered using a random numberingsystem. Students' Perceptual Ability Test (PAT) scores on the DentalAdmissions Test were obtained from school administration. Fiftymandibles (Paradigm Dental Models, San Diego, Calif., US) were mountedin dental simulators (A-December, Newberg, Oreg., US). Seven marks weredrawn on each of the mandibles: one for placement of a central referencepin, two on each side as locations for osteotomy placement, and one oneach side for practice. To provide a standard reference osteotomy, thecentral osteotomy was drilled using a jig. Prior to using the system ofthe present invention, each participant watched an instructional videoshowing the procedural steps and then filled out a survey assessingtheir confidence before the procedure. After performing the osteotomies,participants were again surveyed regarding their post-performanceconfidence with and without use of the sensor and their opinion aboutthe ease of sensor use.

For the study, each participant was evaluated on placing fourosteotomies using visual alignment only (without using the systemaccording to the present invention) with a reference pin placed in thecentral osteotomy, and evaluated on placing four osteotomies using asystem according to the present invention but without a centralreference pin (the reference osteotomy was left open). Each participantinitially placed two osteotomies using a 2 mm twist drill without thesystem to become accustomed to the simulated mandible and the surgicalhandpiece. The participants then drilled four osteotomies using the 2 mmtwist drill without the system in a predetermined order: site 3, site 2,site 1, and site 4 attempting to drill the four osteotomies parallel tothe central reference pin.

Then, the participants drilled four osteotomies at the same locationusing the system according to the present invention by placing the 2 mmtwist drill in the reference osteotomy and recording the firstorientation. After the first orientation was set, the participantsreoriented the system to the second orientation at the osteotomy site.The device was actuated such that, once the first orientation wasrecorded, the signal emitter emitted both a light and a sound wheneverthe device returned to that first recorded orientation. Therefore, aslong as the light and sound were emitted, the drill on the dentalhandpiece was aligned in space with the reference osteotomy. Theprocedures were performed with the manikin in a semi-supine position tosimulate patient positioning in a dental chair.

To measure alignment accuracy, carbon fiber guide pins were placed intoeach osteotomy and the mandibles scanned using an iCAT Cone BeamComputed Tomography machine (Imaging Science International, Hatfield,Pa., US). The files were exported and loaded into Nobel ClinicianSoftware ((Nobel Biocare Services AG, Kloten, Switzerland) forangulation analysis. The angle variation was analyzed using screen shotsuploaded into Google SketchUp (Google, Mountain View, Calif., US) andthe results verified by placing virtual implants using Nobel ClinicianSoftware to record the difference between the angulation of thereference osteotomy and each of the other osteotomies. The data wasanalyzed using a Related Samples Wilcoxon Signed Ranked test with thesignificance level being 0.05. Additionally, the participants ratedtheir confidence level through a survey and students Perceptual AbilityTest (PAT) scores were examined for correlation with osteotomyalignment.

Analyses of the results are given in Table 1.

TABLE 1 Results for Twenty Third-year Dental Students and FiveExperienced Clinicians Site 1 Site 2 Site 3 Site 4 Average betterplacement with system 36% 32% 40% 28% 34% both pins within 4.1° 12% 32%36% 16% 24% worse placement with system 12%  4% 12% 32% 15% both pinsoutside of 4.1° 40% 32% 12% 24% 27%

In addition, there were more outlying placements of the pins when thesystem was not used, than when the system was used. Students with higherPAT scores had rated the sensor as more difficult to use than those withlower PAT scores (P<0.05). There was no significant difference betweenstudents and experienced clinicians in placing the osteotomy parallel tothe reference overall except for Site 1, where the experiencedclinicians placed the osteotomy more parallel when not using the systemthan did the students when not using the system. The experiencedclinicians showed a reduction in angulation error in Site 1, Site 2(p<0.1) and Site 4 (p<0.05) in the buccal/lingual direction when usingthe system. Experience, PAT scores and confidence showed little to nocorrelation to angulation error. Using the system increased confidencelevel of the students but not the experienced clinicians. Experiencedclinicians showed less improvement with the device then did studentparticipants. Perceptual Ability Test scores showed an inverserelationship with reported ease of use of the system (p<0.05).

Therefore, as can be seen, some of the participants showed overallimprovement when using the present system.

Although the present invention has been discussed in considerable detailwith reference to certain preferred embodiments, other embodiments arepossible. Therefore, the scope of the appended claims should not belimited to the description of preferred embodiments contained in thisdisclosure.

What is claimed is:
 1. A device for reducing angulation error duringdental procedures, the device comprising: a) two or more than twosensors that monitor realtime orientation of the device in space; b) aprogrammable computer processor comprising both an input channel and anoutput channel connected to the two or more than two sensors; c) acomputer-sensor interface for connecting to a computer for programmingthe device and for receiving and manipulating data from the device, thecomputer-sensor interface connected to the programmable computerprocessor; d) one or more than one signal emitter connected to thecomputer-sensor interface through the output channel for emitting one ormore than one signal; and e) an actuator connected to the programmablecomputer processor by way of the input channel.
 2. The device of claim1, where the two or more than two sensors is two sensors.
 3. The deviceof claim 1, where the two or more than two sensors is three sensors. 4.The device of claim 1, where the two or more than two sensors areselected from the group consisting of an accelerometer, a gyroscope anda magnetometer.
 5. The device of claim 1, where the two or more than twosensors are an accelerometer and a gyroscope.
 6. The device of claim 1,where the two or more than two sensors are an accelerometer, a gyroscopeand a magnetometer.
 7. The device of claim 1, further comprising anintegral computer connected to the computer-sensor interface forprogramming the device.
 8. The device of claim 1, further comprising anintegral power supply for supplying power to the device.
 9. The deviceof claim 1, where the one or more than one signal emitter is one signalemitter.
 10. The device of claim 1, where the one or more than onesignal emitter is a plurality of signal emitters.
 11. The device ofclaim 1, where the one or more than one signal emitter is two signalemitters.
 12. The device of claim 1, where the one or more than onesignal emitter is three signal emitters.
 13. The device of claim 1,where the one or more than one signal emitter emits one or more than onesignal selected from the group consisting of an audible signal, avisible signal and both an audible and a visible signal.
 14. The deviceof claim 1, where at least one of the one or more than one signalemitter is integral with the device.
 15. The device of claim 1, where atleast one of the one or more than one signal emitter is not integralwith the device.
 16. The device of claim 1, where the actuator isintegral with the device.
 17. The device of claim 1, where the actuatoris not integral with the device.
 18. A system for reducing angulationerror during dental procedures, the system comprising: a) a deviceaccording to claim 1; and b) a dental handpiece connected to the device.19. The system of claim 18, where the device is integrally attached tothe dental handpiece.
 20. The system of claim 18, where the device isreversibly attached to the dental handpiece.
 21. The system of claim 18,where the dental handpiece is a dental drill.